Cladophialophora

• Includes Cladophialophora bantiana and Cladophialophora modesta, which are neurotropic and cause CNS disease
• Other Cladophialophora species may cause mild cutaneous lesions to disseminated disease.

Background

Microbiology

• Cladophialophora bantiana and Cladophialophora modesta, which cause fungal brain abscesses
• Cladophialophora arxii, Cladophialophora emmonsii, and Cladophialophora modesta can cause brain abscess as well as non-CNS disease
• Cladophialophora carionii causes chromoblastomycosis
• Many non-pathogenic species, which can be laboratory contaminants

Epidemiology

• More common in India
• Associated with soil, bark, or carbon-rich environments, like coal mining or sawdust
• More common in gardeners and farmers, but not exclusive
• Unclear if acquired by inhalation or implantation

Clinical Manifestations

• Certain species may present as fungal brain abscess

Diagnosis

• Culture
  • Microscopy
    • Long, delicate, branching chains of hydrophobic brown conidia and lacking yeast cells, with brown septate hyphae
  • The species (and Cladosporium) are differentiated by physiologic tests include temperature tolerance, gelatin liquefaction, cycloheximide growth, urease test, and the nitrate test
• Histopathology is necessary for subcutaneous infections

Management

• Surgical resection is recommended when possible
• CNS disease may not respond to antifungal therapy
• Amphotericin B, flucytosine, caspofungin and terbinafine, or an extended spectrum triazole may be tried when surgical resection is not possible
  • For Cladophialophora bantiana infections, the combination of the three drugs (flucytosine, micafungin and posaconazole) is recommended based on a mouse model1
  • Isavuconazole has very promising responses in CNS infections, though limited data2